Multifaceted Prospective Memory Intervention to Improve Medication Adherence

多方面的前瞻性记忆干预可提高药物依从性

基本信息

批准号：
8092862
负责人：
KATHLEEN C INSEL
金额：
$ 37.96万
依托单位：
UNIVERSITY OF ARIZONA
依托单位国家：
美国
项目类别：
财政年份：
2008
资助国家：
美国
起止时间：
2008-09-30 至 2013-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8092862
关键词：
Address Adherence Adult Age Age-Years Antihypertensive Agents Applied Research Area Behavior Blood Pressure Cardiovascular Diseases Cardiovascular system Cerebrovascular Disorders Cessation of life Chronic Chronic Disease Cognitive Communities Control Groups Cues Dependence Development Disease Dose Education Effectiveness Elderly Electronics Environment Event Health Health Care Costs Heart failure Home environment Hypertension Hypotension Impaired cognition Individual Intention Intervention Investigation Laboratories Measures Medical Medicine Memory Monitor Patients Pattern Performance Pharmaceutical Preparations Phase Population Procedures Process Psychological reinforcement Public Health Quality of life Randomized Research Resources Risk Risk Reduction Short-Term Memory Societies Stroke Testing Time Training Visit age related base blood pressure regulation comparison group cost design disability executive function experience fundamental research group intervention human old age (65+)hypertension control improved innovation medication compliance modifiable risk prevent prospective prospective memory systematic review task analysis

项目摘要

DESCRIPTION (provided by applicant): Adherence to medication is the single most important strategy to prevent high blood pressure and its subsequent deleterious and costly effects including stroke, heart failure and cognitive decline. Adherence is a significant problem in hypertension with estimates of only 50 percent appropriately adhering to their prescribed medications. Hypertension is also an asymptomatic chronic illness and therefore one without internal memory cues to medication taking. Hypertension is prevalent among older adults who have been shown to experience declines in cognitive processes that otherwise might compensate for the lack of internal cues to support adherence. The purpose of the proposed study is to test the effect of an in-home, tailored, multifaceted prospective memory intervention on adherence to antihypertensive medication for adults 65 years of age and older. The intervention is grounded in recent empirical and theoretical developments in the area of prospective memory and focuses on enhancing medication adherence through the use of relatively well-preserved cue- driven and automatic processes. Older adults who are self-managing at least one antihypertensive agent and are adherent to this medication less than or equal to 90 percent following 4 weeks of baseline monitoring, will be randomly assigned to one of two groups. One group will receive the intervention consisting of 4 phases: establishing a relationship, education, implementation of multifaceted strategies to improve prospective remembering and weekly reinforcement sessions for 3 weeks. The education comparison group will only receive part of the first and second phase of the intervention, establishing a relationship and education and will be visited for an additional 3 weeks similar to the visits for the intervention group, but will not receive strategy training. Adherence will be determined using Medication Electronic Monitoring. It is hypothesized that the intervention group will have greater overall adherence and that the relationship between overall adherence and executive function/working memory will be smaller than for the education comparison group because the intervention reduces the need for high levels of executive function to achieve adherence. Patterns of adherence will be assessed across a six-month period. A major public health consequence of this study is limiting disabilities among older adults because hypertension is associated with cognitive decline and cardiovascular and cerebrovascular disease including stroke. While this intervention is being tested with older adults, the intervention has broad implications for improving adherence in other populations. PUBLIC HEALTH RELEVANCE: Taking medications as prescribed is the single most important way to prevent the effects of high blood pressure. This study addresses the important public health problem of high blood pressure by testing an intervention to help people take medications as prescribed. If we can improve the way people take blood pressure medicines, we can improve the quality of life for older adults and decrease health care costs.

描述（由申请人提供）：遵守药物是防止高血压及其随后的有害和昂贵的影响，包括中风，心力衰竭和认知能力下降的最重要策略。在高血压中，依从性是一个重大问题，估计只有50％适当地遵守其处方药。高血压也是一种无症状的慢性疾病，因此没有内部记忆提示服用药物。在被证明在认知过程中经历下降的老年人中，高血压普遍存在，否则可能会弥补缺乏支持依从性的内部提示。拟议的研究的目的是测试一个家庭量身定制的，多方面的前瞻性记忆干预对65岁及以上的成年人抗高血压药物的遵守。该干预措施基于前瞻性记忆领域的最新经验和理论发展，并着重于通过使用相对保存完好的提示和自动过程来增强药物依从性。在基线监测4周后，自我管理至少一种降压药并且遵守该药物小于或等于90％的老年人将被随机分配给两组之一。一个小组将获得包括4个阶段的干预措施：建立关系，教育，实施多方面的策略，以改善预期的记忆和每周的加强课程3周。教育比较小组将仅接受干预的第一阶段和第二阶段的一部分，建立关系和教育，并将访问与干预小组的访问相似的3周，但不会接受策略培训。依从性将使用药物电子监测确定。假设干预小组将具有更大的整体依从性，并且整体依从性与执行功能/工作记忆之间的关系将比教育比较组小，因为干预措施减少了高级执行功能以实现依从性的需求。依从性模式将在六个月的时间内进行评估。这项研究的主要公共卫生后果是限制老年人的残疾，因为高血压与包括中风在内的认知能力下降以及心血管和脑血管疾病有关。尽管这种干预措施正在接受老年人的测试，但干预措施对改善其他人群的依从性具有广泛的影响。公共卫生相关性：服用处方药是防止高血压影响的最重要方法。这项研究通过测试干预措施来帮助人们服用处方药，以解决高血压的重要公共卫生问题。如果我们可以改善人们服用血压药物的方式，我们可以改善老年人的生活质量并降低医疗保健成本。